Optimizing Cardiac Rehabilitation by Integrating Sleep Therapeutics

拟议的CDA-2将为候选人Caitlan Tighe博士提供专门的研究计划 职业发展和指导，以支持她成为一名专注于 开发和评估行为睡眠干预措施以提高老年人的功能和生活质量 患有衰老相关疾病的退伍军人。提赫博士将寻求有指导的培训，以：1)提高她在 老年疾病退伍军人行为睡眠干预研究的设计与实施，2) 建立衡量身体机能(例如，行动能力、脆弱程度)的概念性知识和技能 和症状(例如，疼痛)与这些退伍军人的生活质量有关，3)扩大她在 纳入退伍军人管理局门诊康复的行为睡眠干预措施的发展和适应 和专业医疗护理环境，以及4)增强她的勇气、领导力和组织性 管理技能。这些培训目标得到了她提出的研究的支持，在这些研究中， 跨诊断性睡眠和昼夜节律干预(TRANS-C)将适用于心脏退伍军人 在这一人群中进行康复和试点测试。心脏康复是一项多成分的次要任务 为经历过心脏事件的个人制定的预防计划，包括心脏手术或 疾病的恶化。心脏康复的目标主要集中在身体的恢复 通过体育活动、教育和咨询来发挥功能和降低心血管风险。 接受心脏康复治疗的患者现在比过去年龄更大，医学上也更复杂，这促使 需要扩大心脏康复的范围，以应对心血管疾病以外的因素 有助于发挥功能和提高生活质量。睡眠健康与心血管疾病发病率和死亡率有关，因为 以及与功能和健康相关的生活质量。心脏康复患者通常感觉很差 睡眠健康，然而，它并没有正式干预心脏康复。对睡眠的行为干预 和昼夜节律问题，反式-C的设计是为了促进不同睡眠问题的睡眠健康 严重程度和类型，因此对那些接受心脏康复服务的人有很大的潜力。这个 研究方案借鉴了美国国立卫生研究院的行为干预发展阶段模型。研究 目标1将涉及形成工作，以优化心脏递送的反式-C手册和方案 康复，由退伍军人、内容专家和提供者提供意见。研究目标2将涉及 用小样本(N=10)对改编的TRANS-C手册和方案进行初步测试和改进 参加心脏康复并报告睡眠障碍和/或与睡眠相关的退伍军人 减损。研究目标3将包括一项试点随机试验，以确定可行性、可接受性和 干预方案和研究程序的合理性。心脏康复中的退伍军人睡眠 干扰和/或与睡眠相关的损害将被随机分为TRAN-C+心脏康复组(n=25)或 常规护理(n=25)。睡眠障碍和与睡眠相关的损害，残疾和功能，以及健康- 相关的生活质量将在3个月和6个月时进行评估，以确定测量响应性并提供 初步了解治疗效果。

The proposed CDA-2 will provide the candidate, Caitlan Tighe, PhD, with a specialized program of research career development and mentoring to support her goal of becoming a clinical investigator who focuses on developing and evaluating behavioral sleep interventions to enhance functioning and quality of life in older Veterans with aging-related diseases. Dr. Tighe will seek mentored training to: 1) increase her proficiency in the design and conduct of behavioral sleep intervention research in Veterans with aging-related diseases, 2) establish conceptual knowledge and skills in the measurement of physical functioning (e.g., mobility, frailty) and symptoms (e.g., pain) relevant to quality of life in these Veterans, 3) expand her expertise in the development and adaptation of behavioral sleep interventions for integration into VA outpatient rehabilitation and specialty medical care settings, and 4) enhance her grantsmanship, leadership, and organizational management skills. These Training Aims are supported by her proposed research, in which the Transdiagnostic Sleep and Circadian Intervention (TranS-C) will be adapted for delivery to Veterans in Cardiac Rehabilitation and pilot-tested in this population. Cardiac Rehabilitation is a multicomponent secondary prevention program for individuals who have experienced a cardiac event, including a cardiac procedure or an exacerbation of disease. The goals of Cardiac Rehabilitation primarily center around the recovery of physical functioning and the reduction of cardiovascular risk through physical activity, education, and counseling. Patients in Cardiac Rehabilitation are now older and more medically complex than in the past, prompting a need to broaden the scope of Cardiac Rehabilitation to address factors beyond cardiovascular disease that contribute to functioning and quality of life. Sleep health is linked to cardiovascular morbidity and mortality, as well as functioning and health-related quality of life. Cardiac Rehabilitation patients commonly experience poor sleep health yet it is not formally intervened upon in Cardiac Rehabilitation. A behavioral intervention for sleep and circadian problems, TranS-C was designed to promote sleep health across sleep problems of differing types and degrees of severity thus having great potential to benefit those served in Cardiac Rehabilitation. The proposed research plan draws from the NIH Stage Model of behavioral intervention development. Research Aim 1 will involve formative work to optimize the TranS-C manual and protocol for delivery in Cardiac Rehabilitation, with input from Veterans, content experts, and providers. Research Aim 2 will involve a preliminary test and refinement of the adapted TranS-C manual and protocol with a small sample (N=10) of Veterans who are participating in Cardiac Rehabilitation and report sleep disturbance and/or sleep-related impairment. Research Aim 3 will involve a pilot randomized trial to establish the feasibility, acceptability, and plausibility of the intervention protocol and study procedures. Veterans in Cardiac Rehabilitation with sleep disturbance and/or sleep-related impairment will be randomized to TranS-C + Cardiac Rehabilitation (n=25) or Usual Care (n=25). Sleep disturbance and sleep-related impairment, disability and functioning, and health- related quality of life will be assessed at 3- and 6-months to determine measure responsiveness and provide preliminary insight into treatment effects.